Clinical research| Volume 27, ISSUE 6, P716-724, November 2011

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Long-Term Clinical Outcome After Percutaneous Coronary Intervention in Grafts vs Native Vessels in Patients With Previous Coronary Artery Bypass Grafting

Published:October 24, 2011DOI:



      The long-term clinical outcome of patients with previous coronary artery bypass grafting (CABG), undergoing percutaneous coronary intervention (PCI) is not clear.


      Observational, retrospective study of post-CABG patients, who underwent PCI in either a graft or a native vessel.


      Out of 221 consecutive patients, those with PCI in both native vessel and graft (N = 16) and missing follow-up data (N = 15) were excluded. Out of the remaining 190 patients (age 67.9 ± 9.6 years; 90.0% men), the graft-PCI group (N = 88) had more occluded native vessels (2.1 ± 0.8 vs 1.6 ± 0.8; P < 0.001), and fewer totally occluded grafts (0.55 ± 0.6 vs 0.75 ± 0.8; P = 0.05) compared with the native vessel-PCI group (N = 102). On follow-up (median duration 28 months), the incidence of major adverse cardiac events (MACEs), cardiac death, and repeat revascularization was higher in graft-PCI group compared with native vessel-PCI group (43.2% vs 19.6%, log-rank P < 0.001; 19.3% vs 6.9%, log-rank P = 0.008; and 23.9% vs 12.7%, log-rank P = 0.02, respectively). Graft-PCI was independently associated with higher risk for major adverse cardiac events (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.45-5.57; P = 0.002), cardiac death (HR, 3.44; 95% CI, 1.16-10.22; P = 0.03) and repeat revascularization (HR, 2.41; 95% CI, 1.02-5.72; P = 0.046).


      Post-CABG patients, undergoing graft compared with native vessel-PCI, have worse long-term clinical outcome. Prospective studies are needed to elucidate the optimal revascularization strategy for such patients.



      Les conséquences cliniques à long terme chez les patients ayant eu un pontage aortocoronarien (PAC) et subissant une intervention coronarienne percutanée (ICP) ne sont pas claires.


      Une étude d'observation rétrospective de patients après un PAC qui subissaient une ICP soit dans un greffon ou un vaisseau natif.


      Des 221 patients consécutifs, ont été exclus ceux ayant eu une ICP dans le vaisseau natif ainsi que dans le greffon (N = 16) et ceux dont les données de suivi manquaient (N = 15). Des 190 patients restants (âgés de 67,9 ± 9,6 ans; 90,0 % d'hommes), le groupe ayant subi une ICP dans le greffon (N = 88) avait plus de vaisseaux natifs obstrués (2,1 ± 0,8 vs 1,6 ± 0,8; P < 0,001) et moins de greffons totalement obstrués (0,55 ± 0,6 vs 0,75 ± 0,8; P = 0,05) que le groupe ayant eu une ICP dans le vaisseau natif (N = 102). Durant le suivi (durée médiane de 28 mois), l'incidence d'événements cardiaques indésirables majeurs (ÉCIM), la mort cardiaque et la revascularisation répétée étaient plus élevées dans le groupe ayant eu une ICP dans le greffon que dans le groupe ayant eu une ICP dans le vaisseau natif (43,2 % vs 19,6 %, P < 0,001 selon le test logarithmique par rangs; 19,3 % vs 6,9 %, P = 0,008 selon le test logarithmique par rangs; et 23,9 % vs 12,7 %, P = 0,02 selon le test logarithmique par rangs, respectivement). L'ICP dans le greffon était indépendamment associée à un risqué élevé d'événements cardiaques indésirables majeurs (rapport de risque [RR], 2,84; intervalle de confiance [IC] de 95 %, 1,45-5,57; P = 0,002), de mort cardiaque (RR, 3,44; IC de 95 %, 1,16-10,22; P = 0,03) et de revascularisation répétée (RR, 2,41; IC de 95 %, 1,02-5,72; P = 0,046).


      Les patients ayant eu un PAC et subissant une ICP dans le greffon comparativement à ceux subissant une ICP dans le vaisseau natif ont des conséquences cliniques à long terme plus mauvaises. Des études prospectives sont nécessaires pour élucider la stratégie de revascularisation optimale pour de tels patients.
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